Early diagnosis and treatment of invasive pulmonary aspergiliosis following kidney transplantation

Objective To investigate the early diagnosis and treatment of invasive pulmonary aspergillosis (IPA) infection following kidney transplantation. Methods A retrospective analysis was carried out in 16 IPA patients after kidney transplantation from January 2002 to March 2008. There were 7 males and 9 females with a mean age of 42. 9 years old. The prevalence of IPA was 2. 21%. The induction therapy was given to 12 patients, 5 with CD25 monoclonal antibody and 7 with anti-thymocyte globulin (ATG). All 6 with acute pre-infection rejection were given the methylprednisolone sodium or ATG therapy. Results The intervals between transplantation and diagnosis were largely within 3 months.Persistent or intermittent fever was the main pest-operative symptom High resolution computed tomography (HRCT) of thorax and bronchoalveolar lavage fluid (BALF) for culture were the main evidence of clinical diagnosis. Amphotericin B(0. 15 -0. 5 mg· kg~(-1)· ~ d(-1) )might be the major treatment for IPA because of its satisfactory initial therapeutic effect. The mortality rate was 7/16 (43.75%). Of the 9 surviving patients,8 were treated before the test results were available. Conclusions The clinical symptoms of IPA following kidney transplantation are atypical in the early stage so that it is easy to misdiagnose and a high mortality rate ensues. Major risk factors for IPA include administration of ATG, CD25 monoclonal antibody and steroid boluses for prevention or treatment of allograft rejection; prolonged broad-spectrum antibiotic use after transplantation and environmental factors. Early diagnosis and empirical use of antifungal agents while waiting for a definitive diagnosis are imperative in achieving a favorable outcome. Key words: Invasive pulmonary asperglllosis;  Kidney transplantation;  Diagnosis;  Treatment